Electroconvulsive Therapy in Forensic Psychiatry: A Systematic Review

Area of Science:

• Forensic Psychiatry
• Clinical Psychology
• Neuroscience

Background:

• Patients in forensic hospitals often have schizophrenia and treatment-resistant psychosis, leading to longer hospital stays.
• Electroconvulsive therapy (ECT) is a potential treatment for severe, treatment-resistant psychotic disorders.
• Data on ECT use in forensic psychiatry is limited, necessitating a review of existing evidence.

Approach:

• A systematic review was conducted searching PubMed, Web of Science, and PsycINFO from 1980 onwards.
• Included were peer-reviewed articles detailing ECT treatment outcomes in forensic psychiatry patients.
• Analysis focused on case reports and series with reported treatment outcomes.

Key Points:

• The review identified 6 studies (5 case reports, 1 case series) involving 13 patients treated with ECT in forensic settings.
• Patients diagnosed with schizophrenia spectrum disorders (10) or psychotic depression (3) showed improvement.
• Eleven patients (84.6%) responded to ECT, with reduced aggression and improved functioning; 3 returned to the community.

Conclusions:

• Despite poor evidence quality and high risk of bias, ECT shows potential benefit for forensic psychiatric patients.
• Further research, including prospective, controlled observational studies and qualitative patient perspectives, is crucial.
• Systematic and higher-quality evidence is urgently needed to support ECT's role in forensic psychiatry.